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Utri-Khodadady Z, Głąbska D, Guzek D. Effect of Consuming Salmon Products on Vitamin D Status of Young Caucasian Women in Autumn-A Randomized 8-Week Dietary VISA 2 (Vitamin D in Salmon Part 2) Intervention Study. Nutrients 2024; 16:3565. [PMID: 39458558 PMCID: PMC11510608 DOI: 10.3390/nu16203565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 10/15/2024] [Accepted: 10/17/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Young women are often at risk of vitamin D deficiency, while fatty fish can provide significant amounts of it, which is especially important when no vitamin D skin synthesis is possible due to limited sunshine exposure. This study aimed to analyze the impact of increasing the intake of salmon in various forms (smoked salmon, salmon sausages) on vitamin D status of young women in autumn. METHODS The 8-week intervention involved 120 non-obese women, aged 20-25 years. Participants were randomly assigned to one of three groups: smoked salmon (25 g/day), salmon sausage (100 g/day), or a control group. Both intervention products provided approximately 5 µg of vitamin D daily. Serum concentrations of 25(OH)D as well as vitamin D intakes were assessed pre-, mid-, and post-intervention. RESULTS The median vitamin D intake at baseline was 2.7-3.4 µg/day and did not differ between the groups (p > 0.05), while during the intervention, it was highest in the smoked salmon group (p < 0.001) and amounted to 7.3 µg/day. While all groups experienced a decrease in 25(OH)D serum concentrations, the decrease was significantly smaller in the salmon sausage group compared to the control group (-4.3 vs. -15.0 nmol/L, p < 0.05), and no significant difference was observed between the smoked salmon and control group after 8 weeks (p > 0.05). Moreover, in the salmon sausage group, the intervention was more effective among participants with an inadequate vitamin D status at baseline (25(OH)D change after the intervention: -3.0 vs. -5.4 nmol/L, p < 0.05; inadequate vs. adequate baseline vitamin D status). CONCLUSIONS Increasing the intake of salmon, and hence of vitamin D, was not enough to maintain the vitamin D status of young women in autumn. It seems that other, not-yet-fully-understood factors, may influence vitamin D absorption and/or metabolism, thereby affecting the outcomes of such interventions indicating that further research is needed. Nevertheless, it may be concluded that increasing salmon sausage intake might aid slow down the natural decline of 25(OH)D in young women in autumn.
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Affiliation(s)
- Zofia Utri-Khodadady
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
| | - Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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Hagen IV, Helland A, Bratlie M, Midttun Ø, McCann A, Ulvik A, Mellgren G, Ueland PM, Gudbrandsen OA. Serum concentrations of amino acids and tryptophan metabolites are affected by consumption of a light breakfast: a clinical intervention study in adults with overweight or obesity. BMC Nutr 2023; 9:10. [PMID: 36631895 PMCID: PMC9832616 DOI: 10.1186/s40795-022-00661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Epidemiological studies often investigate amino acids and their metabolites as biomarkers, but do not always consistently use fasting or non-fasting blood samples, or may lack information on the prandial status of the study participants. Since little information is available on the effects of the prandial status on many biomarkers, and since blood is typically sampled early in the day with participants in a fasting state or after having consumed a light meal in many trials, the main purpose of this study was to investigate the short-term effects of a light breakfast on serum concentrations of amino acids and related metabolites. METHODS Blood was collected from sixty-three healthy adults (36 women) in the fasting state and at set times for 120 min after intake of a light breakfast with low protein content (14 g protein, 2218 kJ). Relative changes in serum biomarker concentrations from fasting to postprandial serum concentrations were tested using T test. RESULTS The serum concentrations of 13 of the 20 measured amino acids were significantly changed 60 min following breakfast intake, with the most marked effects seen as increases in alanine (34%) and proline (45%) concentrations. The response did not reflect the amino acid composition of the breakfast. The concentrations of seven kynurenine metabolites were significantly decreased after breakfast. CONCLUSION Consumption of a light breakfast affected serum concentrations of several amino acids and related metabolites, underlining the importance of having information regarding the participants' prandial state at the time of blood sampling in studies including these biomarkers. TRIAL REGISTRATION This trial was registered at clinicaltrials.gov as NCT02350595 (registered January 2015).
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Affiliation(s)
- Ingrid V. Hagen
- grid.7914.b0000 0004 1936 7443Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Anita Helland
- grid.7914.b0000 0004 1936 7443Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Marianne Bratlie
- grid.7914.b0000 0004 1936 7443Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Øivind Midttun
- grid.457562.7Bevital AS, Jonas Lies Veg 87, 5021 Bergen, Norway
| | - Adrian McCann
- grid.457562.7Bevital AS, Jonas Lies Veg 87, 5021 Bergen, Norway
| | - Arve Ulvik
- grid.457562.7Bevital AS, Jonas Lies Veg 87, 5021 Bergen, Norway
| | - Gunnar Mellgren
- grid.7914.b0000 0004 1936 7443Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Haukeland University Hospital, 5021 Bergen, Norway ,grid.412008.f0000 0000 9753 1393Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Per M. Ueland
- grid.457562.7Bevital AS, Jonas Lies Veg 87, 5021 Bergen, Norway
| | - Oddrun A. Gudbrandsen
- grid.7914.b0000 0004 1936 7443Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
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Helland A, Bratlie M, Hagen IV, Midttun Ø, Ulvik A, Mellgren G, Ueland PM, Gudbrandsen OA. Consumption of a light meal affects serum concentrations of one-carbon metabolites and B-vitamins. A clinical intervention study. Br J Nutr 2022; 129:1-10. [PMID: 35899805 PMCID: PMC10024976 DOI: 10.1017/s0007114522002446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/07/2022]
Abstract
The transfer of one-carbon units between molecules in metabolic pathways is essential for maintaining cellular homeostasis, but little is known about whether the circulating concentrations of metabolites involved in the one-carbon metabolism are affected by the prandial status. Epidemiological studies do not always consistently use fasting or non-fasting blood samples or may lack information on the prandial status of the study participants. Therefore, the main aim of the present study was to investigate the effects of a light breakfast on serum concentrations of selected metabolites and B-vitamins related to the one-carbon metabolism; i.e. the methionine-homocysteine cycle, the folate cycle, the choline oxidation pathway and the transsulfuration pathway. Sixty-three healthy adults (thirty-six women) with BMI ≥ 27 kg/m2 were included in the study. Blood was collected in the fasting state and 60 and 120 min after intake of a standardised breakfast consisting of white bread, margarine, white cheese, strawberry jam and orange juice (2218 kJ). The meal contained low amounts of choline, betaine, serine and vitamins B2, B3, B6, B9 and B12. Serum concentrations of total homocysteine, total cysteine, flavin mononucleotide, nicotinamide and pyridoxal 5'-phosphate were significantly decreased, and concentrations of choline, betaine, dimethylglycine, sarcosine, cystathionine and folate were significantly increased following breakfast intake (P < 0·05). Our findings demonstrate that the intake of a light breakfast with low nutrient content affected serum concentrations of several metabolites and B-vitamins related to the one-carbon metabolism.
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Affiliation(s)
- Anita Helland
- Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway
| | - Marianne Bratlie
- Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway
| | - Ingrid V. Hagen
- Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway
| | | | - Arve Ulvik
- Bevital AS, Jonas Lies Veg 87, Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | | | - Oddrun A. Gudbrandsen
- Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway
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Hustad KS, Ottestad I, Olsen T, Sæther T, Ulven SM, Holven KB. Salmon fish protein supplement increases serum vitamin B12 and selenium concentrations: secondary analysis of a randomised controlled trial. Eur J Nutr 2022; 61:3085-3093. [PMID: 35362766 PMCID: PMC9363293 DOI: 10.1007/s00394-022-02857-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/02/2022] [Indexed: 01/23/2023]
Abstract
Purpose The main aim of the present study was to examine the effect of a fish protein supplement made from by-products from production of Atlantic salmon, on blood concentration of micronutrients. Methods We conducted an 8-week double-blind parallel-group randomised controlled trial. In total, 88 adults were randomised to a salmon fish protein supplement or placebo, and 74 participants were included in the analysis of vitamin D, omega-3, vitamin B12, selenium, folate, zinc, homocysteine and mercury. Results During the intervention period, geometric mean (GSD) of serum vitamin B12 concentrations increased from 304 (1.40) to 359 (1.42) pmol/L in the fish protein group (P vs. controls = 0.004) and mean (SD) serum selenium increased from 1.18 (0.22) to 1.30 (0.20) μmol/L (P vs. controls = 0.002). The prevalence of low vitamin B12 status (B12 < 148–221 > pmol/L) decreased from 15.4 to 2.6% in the fish protein group, while increasing from 5.9 to 17.6% in the placebo group (P = 0.045). There was no difference between the groups in serum levels of the other micronutrients measured. Conclusion Including a salmon fish protein supplement in the daily diet for 8 weeks, increases serum vitamin B12 and selenium concentrations. From a sustainability perspective, by-products with high contents of micronutrients and low contents of contaminants, could be a valuable dietary supplement or food ingredient in populations with suboptimal intake. Trail Registration The study was registered at ClinicalTrials.gov (ID: NCT03764423) on June 29th 2018.
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Affiliation(s)
- Kristin S Hustad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Thomas Sæther
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
- National Advisory Unit On Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
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Vikøren LA, Drotningsvik A, Midttun Ø, McCann A, Bergseth MT, Austgulen MH, Mellgren G, Ueland PM, Gudbrandsen OA. Baked cod consumption delayed the development of kidney and liver dysfunction and affected plasma amino acid concentrations, but did not affect blood pressure, blood glucose or liver triacylglycerol concentrations in obese fa/fa Zucker rats. Nutr Res 2021; 92:72-83. [PMID: 34274556 DOI: 10.1016/j.nutres.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
Obesity is associated with changes in amino acid metabolism, and studies show that ingestion of fish proteins influence amino acid composition in plasma and urine, in addition to affecting risk factors for metabolic syndrome. Since the majority of fish proteins consumed by humans are as fish fillet, it is of interest to investigate if cod fillet intake affects amino acid composition and metabolic disorders. We hypothesized that a modified AIN-93G diet containing cod fillet would affect amino acid compositions in plasma and urine in obese rats, and also affect risk factors for metabolic syndrome when compared to rats fed a regular AIN-93G diet with casein as the protein source. Obese Zucker fa/fa rats, a rat model of metabolic syndrome, received diets containing 25% protein from lyophilized baked cod fillet and 75% protein from casein (Baked cod diet), or a Control diet with casein for four weeks. The Baked cod diet affected the amino acid composition in plasma, with e.g., lower glycine, histidine, homoarginine, homocysteine, methionine, proline and tyrosine concentrations, but did not affect amino acid concentrations in urine. The concentrations of markers for kidney and liver dysfunction were lower in the Baked cod group, however blood pressure development, fasting and postprandial glucose, and hepatic triacylglycerol concentrations were similar to the Control group. To conclude, substituting 25% of dietary protein with baked cod fillet affected concentrations of some amino acids in plasma and delayed development of kidney and liver dysfunction, but did not affect blood pressure, glucose concentration or fatty liver.
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Affiliation(s)
- Linn A Vikøren
- Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Aslaug Drotningsvik
- Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | | | | | - Marthe T Bergseth
- Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Maren H Austgulen
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Haukeland University Hospital, 5020 Bergen, Norway; Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
| | | | - Oddrun A Gudbrandsen
- Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway.
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Helland A, Bratlie M, Hagen IV, Midttun Ø, Sveier H, Mellgren G, Ueland PM, Gudbrandsen OA. Effect of high intake of cod or salmon on serum total neopterin concentration: a randomised clinical trial. Eur J Nutr 2021; 60:3237-3248. [PMID: 33576844 PMCID: PMC8354862 DOI: 10.1007/s00394-021-02497-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/22/2021] [Indexed: 12/31/2022]
Abstract
Purpose Primarily, to investigate the effect of high intake of cod (lean fish) or salmon (fatty fish) on serum concentration of total neopterin, a marker of cellular immune activation that is associated with cardiovascular disease. Second, to investigate effects of high cod/salmon intake on antioxidant vitamins and elements essential for activity of antioxidant enzymes. Methods In this randomised clinical trial, 63 participants with overweight/obesity consumed 750 g/week of either Atlantic cod (N = 22) or Atlantic salmon (N = 22) or were instructed to continue their normal eating habits but avoid fish intake (Control group, N = 19) for 8 weeks. Food intake was recorded, and fasting serum were collected at baseline and endpoint. Results Serum total neopterin concentration was reduced in the Cod group (median change − 2.65 (25th, 75th percentiles − 3.68, − 0.45) nmol/l, P = 0.018) but not in the Salmon group (median change 0.00 (25th, 75th percentiles − 4.15, 3.05) nmol/l, P = 0.59) when compared with the Control group after 8 weeks. The estimated daily intake of selenium, iron, magnesium and zinc were similar between all groups. Increased serum concentration of selenium was observed only after cod intake when compared to the Control group (P = 0.017). Changes in serum concentrations of copper, iron, magnesium, all-trans retinol, α-tocopherol and γ-tocopherol were similar between the groups. Conclusion A high intake of cod, but not of salmon, lowered serum total neopterin concentration when compared to the Control group. Clinical trial registration This trial was registered at clinicaltrials.gov as NCT02350595
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Affiliation(s)
- Anita Helland
- Department of Clinical Medicine, University of Bergen, Haukeland University Hospital, 5021, Bergen, Norway
| | - Marianne Bratlie
- Department of Clinical Medicine, University of Bergen, Haukeland University Hospital, 5021, Bergen, Norway
| | - Ingrid V Hagen
- Department of Clinical Medicine, University of Bergen, Haukeland University Hospital, 5021, Bergen, Norway
| | | | - Harald Sveier
- Lerøy Seafood Group ASA, PO Box 7600, 5020, Bergen, Norway
| | - Gunnar Mellgren
- Department of Clinical Science, University of Bergen, 5021, Bergen, Norway.,Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021, Bergen, Norway
| | | | - Oddrun A Gudbrandsen
- Department of Clinical Medicine, University of Bergen, Haukeland University Hospital, 5021, Bergen, Norway.
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Barichella M, Cereda E, Iorio L, Pinelli G, Ferri V, Cassani E, Bolliri C, Caronni S, Pusani C, Schiaffino MG, Giana A, Quacci E, Esposito C, Monti Guarnieri F, Colombo A, Sorbo FD, Cilia R, Sacilotto G, Riboldazzi G, Zecchinelli AL, Pezzoli G. Clinical correlates of serum 25-hydroxyvitamin D in Parkinson's disease. Nutr Neurosci 2020; 25:1128-1136. [PMID: 33151126 DOI: 10.1080/1028415x.2020.1840117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Parkinson's disease (PD) patients have lower levels of serum 25-hydroxyvitamin D (25(OH)D) than the general population. Previous studies have suggested a negative association between 25(OH)D and clinical features of PD, but the data are inconsistent. MATERIALS AND METHODS We conducted a cross-sectional, observational study. Serum 25(OH)D, disease (Hoehn-Yahr stage [HY]) and clinical symptom (Unified Parkinson Disease Rating Scale [UPDRS]) severity and global cognitive functions (Mini-Mental State Examination [MMSE]) were studied in 500 consecutive PD patients not using vitamin D supplements. Information on sunlight exposure and dietary intakes (using a 66-item food frequency questionnaire) were also collected. A convenient sample of age and sex-matched community healthy controls (N = 100) was included as a control group. RESULTS PD patients had lower 25(OH)D serum levels than controls. Deficiency status (<20 ng/mL) was found in 65.6% of patients. 25(OH)D levels were independently correlated to sunlight exposure (P = .002) and vitamin D intake (P = .009). In multivariate models, using a Mendelian randomization approach, lower serum 25(OH)D was associated with more severe disease (HY, P = .035), worse clinical symptoms (UPDRS Part-III total score [P = .006] and dopaminergic [P = .033] and non-dopaminergic subscores [P = .001]) and greater global cognitive function impairment (P = .041). Neither cognitive functions nor clinical features were associated with reduced intake of vitamin D and sunlight exposure. CONCLUSION : Serum 25(OH)D was negatively correlated with disease and symptoms severity, as well as with global cognitive functions. Our study adds to the evidence that low 25(OH)D may affect the progression of PD negatively. Intervention studies in this area are required.
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Affiliation(s)
- Michela Barichella
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Fondazione Grigioni per il Morbo di Parkinson, Milano, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Iorio
- U.S. Riabilitazione Parkinson, Fondazione Gaetano e Piera Borghi, Brebbia, Italy
| | - Giovanna Pinelli
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Fondazione Grigioni per il Morbo di Parkinson, Milano, Italy
| | - Valentina Ferri
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Fondazione Grigioni per il Morbo di Parkinson, Milano, Italy
| | - Erica Cassani
- Fondazione Grigioni per il Morbo di Parkinson, Milano, Italy.,U.S. Riabilitazione Parkinson, Fondazione Gaetano e Piera Borghi, Brebbia, Italy
| | - Carlotta Bolliri
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Fondazione Grigioni per il Morbo di Parkinson, Milano, Italy
| | - Serena Caronni
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Fondazione Grigioni per il Morbo di Parkinson, Milano, Italy
| | - Chiara Pusani
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy
| | - Maria Giulia Schiaffino
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Angelica Giana
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Elena Quacci
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Caterina Esposito
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Francesca Monti Guarnieri
- Clinical Nutrition Unit, ASST G.Pini-CTO, Milano, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Aurora Colombo
- Fondazione Grigioni per il Morbo di Parkinson, Milano, Italy.,Parkinson Institute, ASST 'Gaetano Pini-Cto', Milano, Italy
| | | | - Roberto Cilia
- Parkinson Institute, ASST 'Gaetano Pini-Cto', Milano, Italy.,Present address: Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Giulio Riboldazzi
- U.S. Riabilitazione Parkinson, Fondazione Gaetano e Piera Borghi, Brebbia, Italy
| | | | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson, Milano, Italy.,Parkinson Institute, ASST 'Gaetano Pini-Cto', Milano, Italy
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